Provider Demographics
NPI:1982139937
Name:SOZO PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:SOZO PHYSICAL MEDICINE LLC
Other - Org Name:SOZO PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:AUTUMN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-448-8385
Mailing Address - Street 1:2000 N CLASSEN BLVD
Mailing Address - Street 2:SUITE S. 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6016
Mailing Address - Country:US
Mailing Address - Phone:405-601-7033
Mailing Address - Fax:405-602-1939
Practice Address - Street 1:2000 N CLASSEN BLVD
Practice Address - Street 2:SUITE S. 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6016
Practice Address - Country:US
Practice Address - Phone:405-601-7033
Practice Address - Fax:405-602-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4123111N00000X
OKR0074731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty